Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 53 | AL |
Y | 222Z00000X | Podiatrist | 53 | AL |
NPI | 1003929886 |
---|---|
Provider Name | Dr. Samuel Riase JR. |
First Address | Tuscaloosa, AL 35404-5751 |
Second Address | Tuscaloosa, AL 35404-5751 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2006 |
Last Update Date | 08/07/2007 |